HHS Accepting Physician Clinical Care J-1 Waiver Applications
Posted Jun 20, 2003

As we explained last week (June 13, 2003) in our MurthyBulletin article entitled, Overview : J-1 Visa Waivers (Part 3), available on MurthyDotCom, there are four possible options for obtaining a waiver of the J-1 two-year home return requirement. One of these options is an Interested Government Agency waiver (IGA). An important new avenue for obtaining an IGA waiver became available for physicians on June 12, 2003. On that date, the U.S. Department of Health and Human Services (DHHS or HHS) issued a Notice of Availability of Applications in the Federal Register. This implemented a December 19, 2002 interim-final rule permitting HHS to act as an interested government agency (IGA) for physicians willing to work in medically underserved communities. HHS will review applications while appropriately consulting with state departments of public health, alternative IGAs, and other government agencies. This provides increased availability of IGA waivers for clinical care and fills a need created when the U.S. Department of Agriculture (USDA) ceased acting as an IGA for physicians willing to work in underserved areas of the U.S.

The waiver applications for both clinical and research positions, as well as the instructions and procedures, are available through the HHS WebSite. Waivers must be submitted through the prospective employer. This prospective employer can be a private or a nonfederal institution, organization, agency, or a component agency of HHS. The waiver applications will be processed as they are received.

HHS Clinical Care Waiver Criteria

Employers can request waivers for clinical care via the HHS for a physician who is either a general psychiatrist or a primary care physician. The physician must have completed his/her psychiatry or primary care residency-training program no more than 12 months before the date that s/he intends to commence employment. An exception to this rule has been made for individuals who completed their training programs in June 2002. Simply stated, an individual who applies before October 1, 2003 must have completed his/her primary care or general psychiatric residency no earlier than June 1, 2002. For purposes of this regulation, primary care physicians are: “physicians practicing general internal medicine, pediatrics, family practice, or obstetrics / gynecology and who are willing to work in a primary care HPSA or MUA/P; and general psychiatrists willing to work in a Mental Health HPSA.”

An exchange visitor who applies for an HHS clinical care waiver must execute a statement confirming that s/he does not have pending, and will not submit, other IGA waiver requests while the HHS processes the waiver application. Therefore, it is not possible to pursue multiple IGA waiver requests.

The facility seeking to employ the J-1 exchange visitor must demonstrate that it actively recruited in good faith for U.S. physicians in the recent past but was unable to find a qualified U.S. physician. This can be achieved by providing names of U.S. physicians who applied or were interviewed for the job along with reasons why they ultimately were not hired. Additionally, the facility head must execute a statement to confirm that his/her facility is located in a specific, designated HPSA or MUA/P and that it provides Medicaid and Medicare to eligible patients and the uninsured indigent.

The application must be accompanied by a signed employment contract between the physician and the facility. The contract must be at least three years in duration, for no less than 40 hours per week. The contract must demonstrate that the facility indeed is within a designated HPSA or MUA/P. The contract may be terminable only for cause and may not be terminable by mutual agreement before the three-year period ends, unless the contract is assigned to another eligible facility that the HHS approves. Finally, the contract may not include a non-compete clause limiting the physician’s ability to practice after the three-year commitment at an alternative HPSA or MUA/P.

HHS Clinical Care Waiver Procedure

Individuals applying for an HHS clinical care waiver of the two-year home residency requirement must obtain a case number. This requires that the J-1 exchange visitor complete a Data Sheet and return it to the U.S. Department of State Waiver Review Board along with two self-addressed, stamped, legal-sized envelopes and a $136.00 application fee. The Data Sheet may be obtained at the U.S. Department of State WebSite. It is possible that there will be delays in issuance of case numbers. As a result, individuals may file the waiver application before receiving the case number. Please note, however, that all cases must have a case number or the application will not be forwarded for approval to the DOS Waiver Review Board for consideration.

Employer applicants must also complete the application form and return it with all necessary supplementary information. The supplementary information is detailed on the HHS website and includes the requirement that the exchange visitor complete the Federal Credentialing Program process. This process may take 120 days and HHS will only forward the waiver request to the Department of State once it is complete.

We are very pleased that this avenue has been opened for IGA waivers for physicians. It will provide welcome relief for many physicians willing to work in underserved areas of the U.S. for 3 years. It will also provide better levels of health care to individuals living in the many areas of the U.S. that do not have sufficient numbers of health care providers.